摘要：A homeless mortality surveillance system identifies emerging trends in the health of the homeless population and provides this information to key stakeholders in a timely and ongoing manner to effect evidence-based, programmatic change. We describe the first 5 years of the New York City homeless mortality surveillance system and, for the first time in peer-reviewed literature, illustrate the impact of key elements of sustained surveillance (i.e., timely dissemination of aggregate mortality data and real-time sharing of information on individual homeless decedents) on the programs of New York City’s Department of Homeless Services. These key elements had a positive impact on the department’s programs that target sleep-related infant deaths and hypothermia, drug overdose, and alcohol-related deaths among homeless persons. Homeless individuals have a 1.5- to 11.5- times greater risk of dying relative to the general population, depending on age, gender, shelter status, and morbidity. 1–9 A point-in-time assessment of the number of homeless individuals in the United States found that nearly 650 000 individuals experienced homelessness on a single night in 2010. 10 Roughly two thirds (approximately 400 000) were sheltered. The New York City (NYC) Department of Homeless Services (DHS) has estimated that on any given day at least 49 000 homeless individuals live in NYC, approximately 46 000 of whom are known to be part of the DHS shelter system. 11 A DHS annual outdoor population estimate survey completed in January 2012 12 estimated the number of homeless individuals who live in NYC public areas (e.g., on the street, in parks, or in the subway system) to be 3262. Surveillance, which involves the systematic, sustained collection, analysis, and interpretation of data, can provide insight into the public health challenges faced by a population. 13 Crucial to surveillance is the dissemination of data to stakeholders in charge of programs aimed at improving health within the population. When applied to homeless mortality, surveillance involves timely, ongoing collection of the circumstances and causes of individual homeless deaths as well as rapid dissemination of surveillance information to key stakeholders who work directly to improve the health of the homeless population. The key elements of surveillance—ongoing data collection and rapid data dissemination—allow for the identification and investigation of emerging trends in causes of death among homeless persons and, thus, facilitate the design of appropriate programmatic interventions. Using surveillance data, agencies serving homeless persons can make evidence-based changes to existing health initiatives and develop new initiatives soon after the emergence of new risks. In 2005, after heightened media attention on homeless deaths occurring in public view during the preceding winter, the New York City Council mandated NYC’s health department, the medical examiner’s office, Human Resources Administration, and DHS to conduct surveillance of deaths of homeless individuals and report aggregate data on a regular basis. 14,15 Previously, information about the causes and circumstances of deaths in the homeless population was not systematically collected or readily available to stakeholders committed to reducing morbidity and mortality in NYC homeless populations. The limited available data were mainly retrospective. 4,6 In this essay, we describe the NYC homeless mortality surveillance system and illustrate how key elements of the system (i.e., timely dissemination of aggregate mortality data and real-time sharing of information on individual deaths among homeless persons) have had a positive impact on DHS initiatives to prevent sleep-related infant deaths and hypothermia, drug overdose, and alcohol-related deaths among homeless persons. To our knowledge, the impact of a sustained homeless mortality surveillance system on homeless mortality prevention programs has not been documented in the peer-reviewed literature.
